POPESCU TECHNIQUE REVISITED: REVIEW OF THE LITERATURE AND CASE SERIES

Abstract Introduction Management of vascular malformations depends on size, type, age of the patient, location, dissemination and depth of penetration. Treatment options include propranolol, which reduces endothelial vessel proliferation, minimally invasive sclerotherapy to induce fibrosis, or surgery. In 1985 Valerian Popescu described a new approach to treatment consisting of intra-tumoral ligation by compartmentalization. This technique allows for high doses of the sclerosant agent to be delivered as systemic dissemination is restricted by a series of strangulating suture loops that divide the mass into segments. Methods We describe the management and outcome of two patients who presented with vascular malformations in the orofacial region and were managed using a Popescu suturing technique. Vascular obliteration was achieved by a series of strangulating suture loops placed percutaneously throughout each lesion using a curved needle with a resorbable material (Vicryl). The aim was to segment the vascular malformation into manageable sections for subsequent injection of sclerosant. The compartmentalization also ensured that the sclerosant stayed within these compartments and was not washed out into the general circulation. Results and conclusion Good esthetic outcomes were achieved in very visible areas such as the commissure and the vermillion border. In these areas a surgical resection would have certainly caused a disruption of the aesthetic of the lips and, in the second case, probably an alteration of function. Intra-tumoral ligation can be used safely to achieve control of vascular malformations with good esthetic outcomes.